The journey to creating safety net accountable care in New Jersey

New Jersey's 3-year Medicaid Accountable Care Organization (ACO) Demonstration Project was the result of a bipartisan effort to address the quality and cost issues regarding the State's safety net population. The legislation sets forth a framework that allows communities to customize ACOs to meet the unique needs of their population. Camden, Trenton, and Newark are currently experimenting with implementation at various levels. This article documents the context, journey, challenges, and future direction of the legislation through the accounts of 7 stakeholders whose roles were integral in the process of its creation, marketing, and eventual implementation. Their individual perspectives serve not only as an historical record of events but also as a guide for states seeking reference for implementing their own ACO framework.